I recently purchased 454 gm (1 lb) of the rhizome of Polygonum cuspidatum, in bulk because it is high in resveratrol (read earlier post here)l and far cheaper than prepared Resveratrol capsules. As powder I get 454 gm for the same price that I would pay 72gm as capsules, 6 x cheaper.

This post is about PubMed Article on this supplement.

• “the paper summarized its pharmacological effects, including antibacterial, antiviral, anti-inflammatory, analgesic, cardiovascular system protection, liver protection, anti tumor, improving immunity pharmacology” [2013]
• “and the mutual transformation between polydatin and resveratrol keeps balance; they both have the ability of antioxidative stress in vivo, and polydatin has a better effect than resveratrol, which hints that polydatin may be a substitute for resveratrol in antioxidant for clinical use.” [2015]
• Polydatin supplementation ameliorates diet-induced development of insulin resistance and hepatic steatosis in rats [2015]
• .In vitro and in vivo studies of the inhibitory effects of emodin isolated from Polygonum cuspidatumon Coxsakievirus B₄.[2013]
  • Note: Coxsakievus are associated with many cases of CFS
• 8-Hydroxycalamenene isolated from the rhizomes of Reynoutria elliptica exerts neuroprotective effects both in vitro and in vivo [2013].
• Polydatin alleviates non-alcoholic fatty liver disease in rats by inhibiting the expression of TNF-α and SREBP-1c [2012].

This is available in bulk on Amazon.

NOTE: Chinese knotwood (Polygonum Multiflorum), and Japanese knotwood(Polygonum Cuspidatum) are DIFFERENT. I in-error assumed they were the same, see comment for comparisons between them.

Suggested Dosing

Chinese knotweed supplements are recommended in doses between 8g and 25g per day, or as a tea, according to the Herbal Resource Guide. The Public Health Report notes that Japanese knotweed is the premier herb for Lyme’s disease. It’s suggested as a full-spectrum herb, meaning in its whole root form, in doses of 500mg to 2000mg three to four times per day for eight to 12 months. There may be benefits within two weeks to two months, according to the Public Health Report.

Side Effects

The Herbal Resource Guide notes that Chinese knotweed supplement can be sold in crude or unprocessed forms, as well as those forms that have undergone processing. The unprocessed forms exhibit more of the laxative qualities than the processed forms, and side effects of the supplement may be abdominal upset or loose stools. The Public Health Report says Japanese knotweed should not be used by pregnant women and may lead to a metallic taste in the mouth. The Oregon State University monograph on the concentrated knotweed supplement, resveratrol, notes that a single dose of up to 5g per day has not been found to cause any side effects. It is also not suggested for use in pregnant or lactating women, or in people with estrogen-sensitive cancers because of lack of evidence to prove safety. The herb may interact with several medications, such as blood thinners and drugs metabolized by the P-450 enzyme system in the liver.

The 2009 article cited below is there, BUT you have to navigate a few layer of restrictions. The file is above.

My last post cites a 2009 article that found:

“Faecal microbial flora of CFS patients and control subjects. The mean viable count of the total aerobic microbial flora for the CFS group (1.93×108 cfu/g) was significantly higher than the control group (1.09×108 cfu/g) (p<0.001). There was a significant predominance of Gram positive aerobic organisms in the faecal microbial flora of CFS patients. …This study confirms the previous observation (22), and those reported by other investigators (23) that there was a marked alteration of faecal microbial flora in a sub-group of CFS patients….. In this study the mean total count for Enterococcus and Streptococcus spp. for the CFS group was 52% of the total aerobic intestinal flora, which is significantly higher than the 12% seen in the control subjects (p<0.01). ” largely old hat to readers of this blog, a microbiome dysfunction.

But the study went on to some new interesting stuff, a possible mechanism:

“In this study the NMR-based metabolic profiles of the three intestinal micro-organisms, E. faecalis., S. sanguinis. and E. coli showed that the Gram positive bacteria (Enterococcus and Streptococcus spp.) produce more lactic acid than the Gram negative E. coli. Not surprisingly, these Gram positive bacteria were shown to lower the ambient pH of their environment in vitro as compared to that of E. coli. This suggests that when Enterococcus and Streptococcus spp. colonization in the intestinal tract is increased, the heightened intestinal permeability caused by increased lactic acid production may facilitate higher absorption of D-lactic acid into the bloodstream, henceforth perpetuating the symptoms of D-lactic acidosis. Increased intestinal permeability is also associated with endotoxin release from Gram negative enterobacteria, leading to inflammation, immune activation and oxidative stress, which are cardinal features in a large subset of CFS patients “

This ties in well with observations, for example, some people getting relief by various breathing techniques intended to alter pH of the stomach and intestines.

So, putting on the blinkers and focusing solely on the overgrowth of Enterococcus and Streptococcus, how can someone impact this without getting antibiotics (in some countries, prescribing antibiotics for a condition that is not recognized as needing them, can cost a MD their license)?

• “Among the plants chloroform and isoamyl alcohol extracts of Cumin ( Cuminum cyminum), Clove (Syzygium aromaticum) and Turmeric (Curcuma long Linn) had significant effect against … Streptococcus pyogenes” [2013]
• “Cortex phellodendri showed antimicrobial activity against Streptococcus mutans, while Radix et rhizoma rhei was effective against Streptococcus mitis and Streptococcus sanguis. Fructus armeniaca mume had inhibitory effects againstStreptococcus mitis, Streptococcus sanguis, Streptococcus mutans and Porphyromonas gingivalis in vitro.” [2010] – most of these are Chinese/Japanese medicinal herbs
• “eight herbal extracts could inhibit the growth of Streptococcus sanguinis. Jasmine, jiaogulan, and lemongrass were the most potent,” [2008]
• ” (common Fig) F. carica and  (Olive leaf) Olea europaea leaves inhibited growth of… Streptococcus pyogenes” [2011]
• “onion could inhibit E. coli, …   Streptococcus faecalis [1985] – not recommended because of impact on E.coli
• ” Lemongrass, oregano and bay inhibited all organisms” [1999]
• “especially those of Origanum glandulosum and  (Mediterranean thyme) Thymbra capitata with interesting minimum inhibitory concentration, biofilm inhibitory concentration, and biofilm eradication concentration values” [2014]

Early post on treating Enterococcus cites: Azadirachta indica, Ocimum tenuiflorum, Monolaurin. Streptococcus is associated with excessive histamine, see earlier post.  MedScape Article reveal no effective accepted treatment. A fuller article is (here JASN).

Brain Fog etc caused by lactic-acid

Examining clinical similarities between myalgic encephalomyelitis/chronic fatigue syndrome and D-lactic acidosis: a systematic review [2017]

cites:

• “Higher levels of d-lactate producing bacteria (such as Streptococcus and Enterococcus) have been identified in stool samples from patients with ME/CFS “
• Shared with acidosis and ME/CFS “B1. Encephalopathy/Mental confusion/disorientation/dazed/Concentration difficulties/Slow processing and responding to questions/slow speech
  
  B2. Headaches/Muscle pain
  
  B3. Drowsiness/sleepiness/somnolence
  
  B4a. Blurred vision
  
  B4b. Weakness/hypotonic (lowered muscle tone)/flaccidity/impaired gait (staggering/wide/ataxic/unsteady/instability)/ataxia (movement and co-ordination difficulties)/impaired balance”

Antibiotic Approach

The prime bacteria to reduce are Enterococcus and Streptococcus. After the antibiotic, you want to have E.Coli back fill the spaces created by the above being killed.

Probiotic approach

“… Recently, considerable progress has been made in the isolation of these strictly anaerobic butyric acid-producing bacteria from the human gut. It has been shown … that lactic acid, produced in vitro by lactic acid bacteria, is used by some strictly anaerobic butyrate-producing bacteria of clostridial cluster XIVa for the production of high concentrations of butyric acid (Louis & Flint, 2009). This mechanism is called cross-feeding …” [Source]

This implies that miyarisan (clostridium-butyricum) should be of benefit.

E.coli probiotics (symbioflor-2, mutaflor) will displace the high producers and produce a lot less (around 2%) of what the high producers do.

“Lactomin[300 mg Lactobacillus acidophilus, 300 mg Bifidobacterium longum] was discontinued, and she was treated with sodium bicarbonate and oral antibiotics. The probiotics the patient had taken were likely the cause of D-lactic acidosis ” [2010]

Supplement Approach – Thiamine (Vitamin B1) and NAC

100 mg every 12 hours is reported to reverse this for other conditions.

• “Thiamine replenishment at intravenous doses of 100 mg every 12 h resolved lactic acidosis and improved the clinical condition in 3 patients.” [1997]

B1 (at sufficient high dosages) have had major improvement of symptoms. See these posts also:

• B1 variation
• B1 Thiamine

“We concluded that the patient had metabolic acidosis induced by accumulation of 5-oxoproline. We modified her antibiotic treatment, administered acetylcysteine (NAC), and her acidosis resolved.” [2016]

Classification

Cohen and Woods devised the following system in 1976 and it is still widely used:^[1]

• Type A: lactic acidosis occurs with clinical evidence of tissue hypoperfusion or hypoxia is likely what is seen in CFS. The hypoperfusion is well reported as a signature of CFS.

Testing for D-lactic Acidosis

This is a specialized test that is usually not done [Mayo Clinic] “Routine lactic acid determinations in blood will not reveal abnormalities because most lactic acid assays measure only L-lactate. Accordingly, D-lactate analysis must be specifically requested (eg, DLAC / D-Lactate, Plasma). “

Word on Likely Dosage

The last article cited an article treating it. I noticed that often there was very high dosages.  My gut feeling (no evidence to back it up) is that for any of the above, we may well be talking 8 – 16 “00” capsules per day of each one, with a possible change of the herb/spice every 7 days. Remember we are talking about reducing from 52% to 12%, not a walk in the park.

As always, consult with your knowledgable medical professional before starting or changing supplements.

Probiotics to avoid

L. delbrueckii bulgaricus (ATC 11842) has a 26:7 ration of D-Lactic acid to L-Lactic Acid [Source]

Root cause: Low Veillonella?

See this post: on what this bacteria does with lactic acid.

Bottom Line

“Management includes correction of metabolic acidosis by intravenous bicarbonate, restriction of carbohydrates or fasting, and antibiotics to eliminate intestinal bacteria that produce D-lactic acid.” [2017]

“Main treatments are: 1) changing the abnormal intestinal flora with the administration of oral antibiotics, 2) attempt to diminish the quantity of substrate for intestinal fermentation by using the low-carbohydrate diet or enteral formulas containing fructose or starch instead of glucose as the main source of carbohydrate, 3) correction of the underlying abnormality by reanastomosing the intestine in case of intestinal bypass, 4) nonspecific therapy of acidosis with high doses of bicarbonate, 5) correction of the acidosis and simultaneous clearance of D-lactate with hemodialysis3, 4). Antibiotics control symptoms and prevent recurrence of the syndrome in most patients, but in some patients acidosis recurs despite the antibiotic use. Antibiotics that have been tried include neomycin, vancomycin, ampicillin, kanamycin, and metronidazole. The optimum duration of antibiotic therapy is uncertain because the symptoms may recur in a few days after discontinuation of antibiotics in some patients, while others may remain without symptoms for several years in the absence of oral antibiotics4).” [2006]

B1, NAC and sodium bicarbonate taken together are a likely good starting point. Of the antibiotics listed above, I would opt for metronidazole because of the positive results reported in surveys of CFS patients, Probiotics would be any E.Coli probiotic. Any (or multiple) of the above herbs.

Resveratrol is an extract from the skin of grapes, blueberries, raspberries, and mulberries. This week’s edition of New Scientist found suggested significant benefits for Alzheimer’s disease, with dosages of up to 1 gm/day showing no ill effects [2015]. I view all illnesses with significant cognitive issues likely being more extreme cases of the CFS mechanisms. On the flip side, the same study found “Brain volume loss was increased by resveratrol treatment compared to placebo.” (“A working hypothesis [of brain volume loss] is that the treatments may reduce inflammation (or brain swelling) found with Alzheimer’s.” [2015]

 

• Resveratrol protects β amyloid-induced oxidative damage and memory associated proteins in H19-7 hippocampal neuronal cells[2015].
• Neuroprotective effects of resveratrol in Alzheimer disease pathology[2014].
• Neuroprotective action of resveratrol.[2014]
• etc 100 + on this and neurological impact 

I use resveratrol/grape seed extract regularly based on it’s characteristics for coagulation, some 19 studies. For example, One-year consumption of a grape nutraceutical containing resveratrol improves the inflammatory and fibrinolytic status of patients in primary prevention of cardiovascular disease [2012]. One of the reasons is that it have a plasma half-life of 9 hr [2004] longer than aspirin (which also inhibits platelet aggregation) which is 20 minutes [2004]

• Antithrombin effect of polyphenol-rich extracts from black chokeberry and grape seeds [2013].
• Antithrombotic effect of grape seed proanthocyanidins extract in a rat model of deep vein thrombosis.[2011]

My usual preference is “whole source” (i.e. grape seed, blueberries, etc) instead of extracts — because nature likely has auxiliary compounds that are also helpful. The extract usually comes from attempts to commercialize the effective whole source.

Botttom line: Resveratrol / grape seed extract is a positive for CFS as I mentioned in my earlier post.

• decrease platelet aggregation, increase platelet-derived NO release, and decrease superoxide production [2001]
• strong antioxidant activity, antibacterial, antiviral, anticarcinogenic, anti-inflammatory, anti-allergic, and vasodilatory actions, inhibit lipid peroxidation, platelet aggregation, capillary permeability and fragility [2000]

With a daily dosage of 1000 mg/day being found to be safe and in the case of Alzheimer’s, effective – I would suggest discussing with your medical professional a dose of 500 mg/day which is well above the typical dosages recommended on bottles.

Last weekend while cleaning up storage, I came across our old Bounce Back Chair. A device that looks like below:

The reason we go it was that it was recommend by Dr.Cheney in 1998, 1999,

“Less ill patients can add aerobic exercises between five-minute periods of bouncing per the videotape instructions. Its advantages include correcting dysautonmia, the dysfunction of the autonomic nervous system that underlies many of the symptoms in CFIDS. The Bounce Back Chair was studied by NASA to treat astronauts returning from orbit who fainted upon standing. After six months in orbit, you lose your autonomic nervous system capacity to stand in a gravitational field. You simply faint and seize. If you remember these astronauts, when they took them out of the capsule they had to drag them out vertically because they would faint on standing. They end up with a dysautonomic condition similar to chronic fatigue syndrome patients.

NASA figured out that the best way to bring back the autonomic nerve system was to bounce. So they put them in these bungee cord contraptions and they just bounced them–this up and down motion essentially regulates autonomic tone and improves the autonomic nervous system. Rebound exercise is very easy, it’s non-weight bearing, and you can add in arms, legs and abdominal motion while bouncing, to tolerance. It also improves immune regulation by pumping lymphatic fluid back into the blood. Lymph acts just like gamma globulin. Finally, this exercise was shown by NASA to be 68% more efficient as an exercise routine than running. (“Efficient” means maximum gain for minimum effort.) It is therefore ideal for people with little energy to spare. Those who do not suffer from balance problems can achieve many of the same benefits from a mini-trampoline.” [1998/1999]

Well, I reassembled it and use it well watching TV. In general, I feel better after bouncing for a while.

I went over to PubMed and found a single study with inconclusive results when it was combined with some 6 other alternative therapies. The best that I could find was:

• “Up to now, underlying mechanisms are poorly understood although decreased gastrointestinal blood flow, neuro-immuno-endocrine alterations, increased gastrointestinal motility, and mechanical bouncing during exercise are postulated. Future research on exercise associated digestive processes should give more insight into the relationship between physical activity and the function of the gastrointestinal tract.” [2001]
• “Well-designed prospective randomized trials evaluating the risks and benefits of exercise and physical activity on gastrointestinal disorders are recommended for future research.” [2011]

The cost is unreasonable high given the actual construction. More fashionable chairs that seem to emulate the same concept, the Swopper are even more expensive.

Reviewing the various boards, the feedback appears to be good.

• http://forums.prohealth.com/forums/index.php?threads/bounce-back-chair.183391/

Alternative for people in europe:
https://www.manomano.es/hamacas-sencillas/hamaca-sillon-colgante-color-nat-azul-630535

Depending on the amount of bounce, the top cords could be replaced with bungee-type cords

If you find one at a charity organization, pick it up and try it. There is no PubMed evidence supporting its use